Priapism - Treatment

Treating priapism

Treatment for priapism will depend on the type of priapism you have.

High blood flow (non-ischaemic) priapism may not need treatment. A few cases get better on their own after a few hours.

If you have injured your genital area, and you have a painful and persistent erection, seek immediate medical assistance from your nearest accident and emergency (A&E) department. If it’s not treated within 24 hours you may have difficulties getting an erection in the future.

You may need surgery to temporarily prevent the flow of blood into your penis (see below).

If you are diagnosed with low blood flow (ischaemic) priapism, or have an episode of recurrent (stuttering) priapism, aspiration or sympathomimetic injections may be recommended.

The aim when treating recurrent priapism is to prevent further episodes.

Aspiration

Aspiration is the first treatment recommended for priapism.

Your penis is numbed with a local anaesthetic and a small needle and syringe is used to drain blood from your penis.

In some cases, the blood vessels may be ‘washed out’ with sterile water to get rid of any debris. This is known as irrigation.

Aspiration and irrigation usually help relieve painful symptoms and may result in your erection subsiding. However, you may need a number of treatment sessions before this happens.

Sympathomimetic injections

If your symptoms do not respond to aspiration, the next step is to inject a type of medication known as a sympathomimetic directly into the tissue of your penis.

Sympathomimetics work by squeezing the blood vessels in your penis, helping them push blood out of your penis while also preventing more blood from being pumped in.

A type of sympathomimetic called phenylephrine is usually recommended because it has a lower risk of causing side effects compared with other sympathomimetics.

Side effects of phenylephrine include:

an increase in blood pressure, which can make you feel dizzy and lightheaded

If you have a health condition that could be made worse by an increase in blood pressure, such as heart disease, you will need regular blood pressure checks and electrocardiograms (ECGs). An ECG measures your heart's electrical activity.

Surgery

Surgery may be recommended if your symptoms fail to respond to aspiration or sympathomimetic injections. There are several surgical procedures available, depending on the type of priapism you have.

If you have ischaemic priapism, shunt surgery may be recommended. It involves creating a new route for blood to flow out of the penis.

This surgery is only effective if performed within a few hours of the development of the priapism, so it is important that you attend hospital quickly.

A small number of men who have surgery for priapism experience erectile dysfunction afterwards. The risk is greater where the priapism has lasted a long time.

You should discuss the pros and cons of surgery for priapism with your surgeon beforehand.

If you have non-ischaemic (high blood flow) priapism, a surgical technique called embolisation may be used. It aims to stop the flow of blood into your penis by inserting a small device to block the damaged artery.

Medicines for recurrent (stuttering) priapism

The most commonly used medicines are:

gonadotrophin-releasing hormone (GnRH) agonists or antagonists

antiandrogens such as flutamide or bicalutamide

These medicines lower the levels of the hormone testosterone in your blood, which reduces the likelihood of getting an erection.

Hormonal treatments have potential side-effects so are only recommended for use in adult men. The use of other drugs to manage recurrent priapism is limited due to side-effects or lack of data regarding their safety.